2, 15 Its half-life, about 6 hours, is the shortest of all the second-generation antipsychotics. Quetiapine is available as an oral tablet in an immediate-release formulation (time to peak plasma level 1.5 hours) and an extended-release formulation (6 hours). PHARMACOKINETIC PROFILE LENDS ITSELF TO ABUSE These emerging patterns of abuse, along with the drug’s potential metabolic and cardiac complications, signal the need for caution for use in the general patient population. 9 Those who abuse quetiapine typically consume high doses, which has led to several cases of accidental overdose, some of which have been fatal. 9 These trends appear to be more prevalent in correctional facilities (where commonly abused drugs are not readily available) and among patients with a previous history of substance abuse. 10 There are also reports of quetiapine use for “self-detoxification,” in an effort to mitigate withdrawal symptoms from other substances such as alcohol, cocaine, benzodiazepines, and opioids. Quetiapine, used alone, does not produce euphoria or other pleasurable effects typically associated with drugs of abuse, but it can enhance or counter the side effects of substances such as marijuana, cocaine, and heroin, 9 a practice that is colloquially referred to as “seroquelling.” Although the mechanism underlying its rewarding effects remains elusive, misuse of the drug may be driven by its ability to counteract overstimulation caused by other substances of abuse. Prescriptions for quetiapine to treat sleep disturbances have also increased in Australia, New Zealand, and the United Kingdom. Quetiapine ranked fourth among frequently prescribed medications, following the “Z-drugs” (the benzodiazepine receptor agonists zolpidem, zaleplon, and eszopiclone), trazodone, and benzodiazepines. 4īertisch et al, 5 using US National Health and Nutrition Examination Survey data from 1999 to 2010, found that nearly 3% of 32,328 respondents reported having used a commonly prescribed insomnia medication over the previous month. 2 The pattern was similar in the United States from 1996 to 2003, with up to 70% of prescriptions for second-generation antipsychotics being written for conditions other than psychosis. 1 In Canada, prescriptions written by family physicians for quetiapine increased 300% from 2005 to 2012, with a 10-fold increase in its use for sleep disorders. Second-generation antipsychotic use has increased worldwide, with quetiapine, risperidone, and olanzapine being the most frequently prescribed. This article focuses on the use of quetiapine for treating insomnia, its basic pharmacology, evidence of efficacy, and adverse effects, and it provides recommendations for clinical monitoring of patients receiving the drug. However, its cardiometabolic effects and potential for abuse warrant caution for its off-label use. 4 It is generally regarded as being nonaddictive and having a good safety profile. Rather, quetiapine is increasingly being used off-label, including for insomnia, anxiety, agitation, and posttraumatic stress disorder (PTSD). 1, 2 Despite its approval by the US Food and Drug Administration (FDA) only for the treatment of schizophrenia, bipolar disorder (depression, acute mania, and maintenance), and major depressive disorder (as an adjunct medication), 3 only a minority of patients filling prescriptions for quetiapine have these diagnoses. Prescriptions for quetiapine (Seroquel), a second-generation antipsychotic medication, have risen sharply in recent years. Quetiapine carries particular risks for elderly patients. The use of quetiapine to treat insomnia should be confined primarily to patients with comorbid mood or schizophrenia spectrum disorders.Ĭompared with many other antipsychotic drugs, quetiapine is less associated with dystonia and extrapyramidal side effects but tends to cause weight gain, metabolic syndrome, and QTc prolongation.īody mass index, weight, blood pressure, fasting glucose, and lipid levels should be measured before starting treatment and then regularly monitored, even for low doses.ĭespite having no euphoric effects, quetiapine is often abused to enhance or counter side effects of illicit drugs. Quetiapine affects multiple central nervous system receptors, resulting in a variety of effects, including sedation.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |